National Institute for Health and Care Excellence

Debate between Lord Naseby and Lord Kamall

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I am aware of some of those issues, but I wonder whether the noble Lord could write to me with some more specific examples. In my meetings with various organisations, including the Health Technology Alliance and others, wherever they have raised these issues we have looked at them. The NHS, the department, NICE and others are trying to work with suppliers, manufacturers and providers to see how it can be more responsive. If we are going to realise the life sciences vision, we have to make sure that we make the best of the NHS as a global centre of excellence and show that we are at the forefront of research.

[Lord Naseby (Con)]

While we all understand the importance of NICE, can my noble friend reassure us that NICE is working within a fixed budget at this difficult financial time?

[Lord Kamall (Con)]

I think my noble friend will find that lots of departments and lots of public bodies are working within budgets at the moment, given the financial situation. NICE is very aware of this, and has looked at how it can do more with the same money to increase capacity and be more responsive.

Respiratory Viruses

Debate between Lord Naseby and Lord Kamall

Tuesday 11th January 2022 Lords Chamber

[Lord Kamall (Con)]

There are a number of innovations when it comes to vaccines and testing for vaccines. Indeed, some of the companies and organisations we spoke to recently about future testing requirements, for example, have looked at multiple tests or tests where you can identify multiple conditions. It is one of the things that the department and the NHS are continuing to have conversations on with suppliers.

[Lord Naseby (Con)]

I congratulate my noble friend on the success of the flu jab and the way it has worked this year through general practice. In passing, I also reflect on the pre-testing of children going back to school and having a test just before school. There remains a concern, though, about the elderly who are housebound. There was a problem with ensuring extra Covid jabs for that category. Will my noble friend ensure that general practices check on a regular basis where appropriate that there are such jabs as are necessary for the housebound who are eligible?

[Lord Kamall (Con)]

I thank my noble friend for congratulating me, but I should not take any credit for this; it is thanks to the dedication of all the people who work in our health and social care system, and the innovation we have seen in the public and private sectors over many years to tackle many of these conditions. I will look into access for elderly people at home and commit to write to my noble friend.

Covid-19: PCR and Lateral Flow Test Providers

Debate between Lord Naseby and Lord Kamall

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I do not have the exact numbers, so I will write to the noble Baroness. On loss-leading services, anything under £15 was removed because it was deemed that that was dishonest or underpriced.

[Lord Naseby (Con)]

Following on from that question, I remind my noble friend that, as far as I am aware, all the PCR tests are endorsed by Her Majesty’s Government, but the price varies from £60 to over £120. In that condition, if they are endorsed, will my noble friend talk to the companies concerned and decide on a recommended price level?

[Lord Kamall (Con)]

When I was discussing this with the people responsible for accreditation, they said that often a number of companies are reported to them and they look into them. Quite often companies will then be removed, but they can come back. The issue is that companies sometimes get provisional approval at the first stage while they are going through the full approval process. That will be reviewed in time.

Medical Schools: Training Places

Debate between Lord Naseby and Lord Kamall

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for that question and for the advice and expertise that she has passed on to me in my short time in this place. As part of the expansion, we have opened five new medical schools across England, in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. Sometimes we have the training, but it is difficult to find doctors in certain locations. We have tried to move training as close to those locations as possible.

[Lord Naseby (Con)]

My Lords, as well as increasing the numbers, is it not equally important that we ensure that every newly qualified doctor, on whom we spend well over £200,000, signs up for at least four years in the NHS, as do every male and female who joins our Armed Forces today?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion. I will look into it and get back to him.

Covid-19 Update

Debate between Lord Naseby and Lord Kamall

Wednesday 8th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for that question. As far as I am aware, the places administering the booster should be able to give that advice. For example, when I walked in for my booster, they asked which vaccines I had previously had and said that the half-dose I had was sufficient. When I asked about my children, they told me which vaccine was more appropriate for that age group, depending on which vaccine they had. If that advice is not available at the place of vaccination, please let me know. I was not aware of that and I promise that I can look into it.

While I am here, I realise that I did not answer the question from the noble Baroness, Lady Thornton, about the R number. It is currently at 0.9 to 1.1; the latest growth rate range for England is minus 1% to plus 1% per day. As the omicron data comes in, that may well increase, but we have looked at all these measures and are being as precautious as we can in balancing everything up.

In response to the earlier question about the pass—I apologise for the long answer—I have just been told that the NHS has tweeted:

“We are aware of an issue affecting access to the NHS COVID Pass on the NHS App and website. We are investigating this as a priority and will update as soon as we can”.


Clearly, the NHS has been listening to this debate and discussion, and I thank the noble Baroness for raising that. I am sure that noble Lords will agree that that tweet shows the effectiveness of having this debate, so that we can share as much information with the public as possible. I repeat this request: if any noble Lords are aware of any particular problems with the rollout, information et cetera, please let me know and I will investigate as quickly as I can.

[Lord Naseby (Con)]

Last evening, I mentioned to my noble friend the predicament of the 300,000 people who are housebound and cannot go and get a vaccination. I appealed to the Minister, saying that every GP practice knows who these housebound people are and where they live. Will my noble friend now commit himself and the NHS to making sure that every GP practice is asked to go out and give vaccinations to the 300,000 mainly elderly people who are awaiting vaccination?

[Lord Kamall (Con)]

I thank my noble friend for that question. As far as I am aware it has always been the advice that, if people are housebound, they should be able to receive their vaccination in their home. If my noble friend knows of any incidents where that has not happened, please let me know and I will chase them up.

Cigarette Stick Health Warnings Bill [HL]

Debate between Lord Naseby and Lord Kamall

2nd reading
Friday 3rd December 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I add my congratulations to my noble friend on progressing his Private Member’s Bill to this stage and on securing this important debate.

Over the past two decades the UK has introduced a range of public health interventions and a strong regulatory framework to help smokers quit, and to protect future generations from using tobacco. Thanks to these, smoking rates in England are down to a record low of 13.9%, from 19.8% in 2011. If we go back even further, we see that the smoking rate was at 45% in the 1970s. As the noble Baroness, Lady Merron, has said, these reductions have been cross-party; Governments of all colours have tried to tackle this issue.

Those reductions are something we should be very proud of but not complacent about. While we celebrate this success, we recognise that there are still 6 million smokers in England, with smoking remaining one of the biggest causes of preventable mortality and, as a number of noble Lords have acknowledged, one of the largest drivers of health disparities. One of the reasons why I am very pleased that we now have the Office for Health Improvement and Disparities is that there will be a laser-like approach in the attempt to tackle these disparities.

Smoking rates still range from 23.4% in Blackpool to 8% in Richmond upon Thames. In addition, smoking rates vary significantly among certain groups. Nearly one in 10 pregnant women still smoke, increasing the risk of health problems for their babies. The Government are determined to reduce smoking rates in groups that smoke disproportionately, as well as across the board—so, work is going on not just in respect of pregnant women but elsewhere. For example, we know that 23% of routine and manual workers smoke, while the rate among people with long-term mental health conditions is nearly 26%. That is why there is so much to do. We have to make sure that we understand those parts of communities where we can, laser-like, focus our action. That is why the Government have set the bold ambition for England to be smoke free by 2030.

The Government recognise the good intentions behind the Bill. I pay tribute to my noble friend Lord Young of Cookham not only for the Bill but for his long-standing commitment to encouraging smokers to quit. My noble friend himself has told me about his work in the 1970s but also as a Health Minister in the 1980s. Let no one be in any doubt that the Government are clear that we strongly support measures to stop people smoking but also to educate current smokers of its dangers. We have already introduced a number of measures, such as graphic health warnings on tobacco packaging and information on packs giving further advice on how to quit.

While we sympathise with the aims of the Bill, we believe that policy should be evidence-led. It is therefore vital that we conduct further research to build up a strong evidence base to support measures before bringing them forward. To date, sadly, no country has introduced such a measure so there is very little evidence so far on its impact in supporting smokers to quit, compared with other measures we are looking at. Several other measures have been tried in other countries—for example, warnings inside the pack as well as outside—and there are a number of other issues we are examining.

The Government are in the process of developing a new tobacco control plan that will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda. We want to explore a broad range of new regulatory measures to support our ambition to be smoke free by 2030. So, I reassure noble Lords that we will be reviewing this proposal as part of that work.

I turn to some of the specific questions that were asked. A number of noble Lords asked about the tobacco control plan. Rather than implementing blanket measures that may not always reach some of the communities that need to be reached, we want to ensure that the plan has an even sharper focus on disparities and that it supports the Government’s levelling-up agenda. We need bold but impactful proposals. With the establishment of the Office for Health Improvement and Disparities, we are going to draw on its advice on how to address the high levels of smoking among some of these groups, and harness that advice to develop robust and effective proposals that will ensure that our plan delivers the smoke-free 2030 that this country deserves.

We are developing policy for the tobacco control plan and intend to publish it next year. There is a current tobacco control plan, which runs until 2022. We hope to include a number of measures that focus on health disparities and groups where smoking rates are not falling fast enough. I have already mentioned pregnant smokers and smokers with mental health conditions, but that also includes smokers in many deprived parts of the country.

We were asked about the amendments to the Health and Care Bill. We were grateful for the suggested amendments, which show support for strong tobacco control, but once again we need to see the evidence and make sure that such measures are targeted at groups we want to encourage, as well as more generally. At this stage we do not believe we should accept the amendments but, as I have said, next year we will be publishing our new tobacco control plan, since the current one runs until 2022.

Some of these examples include stop smoking services, which we have found produce high quit rates of 59% after four weeks. Since 2000, they have helped nearly 5 million people to quit. We have also protected a public health grant over the course of the spending review to ensure that local authorities can continue to invest in stop smoking services, because they have been seen to be successful. As long as they are successful, they will continue to be part of our armoury.

The noble Lord, Lord Moylan, asked about evidence. The Office for Health Improvement and Disparities continues to monitor developments in tobacco control across the world. We share our knowledge with international partners and draw on their evidence-led experiences to make sure that we are introducing effective measures, rather than just introducing measures we feel might work without evidence.

The noble Lord, Lord Rennard, talked about youth smoking. He is absolutely right, but youth smoking rates continue to decline, and they are currently at their lowest rate on record. In 2018, 5% of 15-year olds were regular smokers, 2% of 11 to 15 year-olds were regular smokers, and 16% had never smoked. While the youth rates are declining, we should not be complacent. We know that smoking remains an addiction largely taken up in childhood, with the majority of smokers starting as teenagers and then becoming addicted. We want to build on that recent success and protect young people from harmful tobacco, and we have an area of focus targeted at that.

My noble friend Lord Naseby talked about the tobacco levy. We recognise that the tobacco industry is already required to make a contribution to the public finances through tobacco duty, VAT and corporation tax—in many ways, it pays our wages. The department will continue to work with HMT regarding tobacco taxation and revenue funding. This includes reviewing options such as the future levy, but we want to make sure that it is an effective way to raise additional funds to support stop smoking services.

The noble Baroness, Lady Uddin, was very honest in her appraisal of her ability to stop smoking in her family. But she made some interesting points, not only about having failed to prevent her family smoking but about whether young people will read the warnings on the cigarettes. I think that is a point we have to look at. Will they be dismissed, just as the effectiveness of the warnings on the outside has waned over time? Will the same thing happen here?

[Lord Naseby (Con)]

As I mentioned, I spent 20-odd years in advertising. The Bill says that the warning has to be in red on blank white paper—quite frankly, that will be very difficult to read. If my noble friend is serious about this, I suggest he takes advice from those who know a little more about printing.

[Lord Kamall (Con)]

I thank my noble friend Lord Naseby for that intervention; I will take account of his advice. In fact, I want to thank him for his advice, given the number of years he spent in the advertising industry. Something we are looking at generally in the public health approach in this country are those experts from the advertising industry who have looked at behavioural studies and behavioural economics to encourage people to buy their products or to smoke, and to attract a number of them—as poachers turned gamekeepers—to help us understand the skills they use to attract smokers and people eating high-fat food, and to turn that around to discourage people from taking up smoking and eating food that might cause obesity.

The noble Baroness, Lady Uddin, also talked about smoking in pregnancy, and we recognise this problem. It is sad that 10% of pregnant women still smoke, and they are not falling in line with other groups. Therefore, we are looking at how we address that at prenatal and neonatal clinics, but also during that whole experience. How do we reach those mothers, and would that really be effective?

One of the questions asked was about a number of different ideas that came up. Basically, we want to follow the evidence. That is really important. There is a tobacco plan already in progress, which will end in 2022. Next year, in 2022, we will publish the new tobacco plan, and we are looking at evidence from around the world and at what works. But we also want to see how we can work across government. For example, we are working closely with the Department for Education to ensure that the harms of smoking are in the curriculum, but many of us will remember being at school and receiving education on a number of different issues related to lifestyle. A number of my friends would say, “I’m never going to smoke or drink”, and two years later, I would see them at parties, smoking and drinking.

Therefore, we have to understand how effective these messages are, how long they work for, and how we can make sure that they continue to work. We understand and accept that we need to continue to take action; we must not be complacent. We want to look at the evidence: some 64,000 people still die each year from smoking; two-thirds of long-term smokers will die from it; it is one of the greatest drivers of health disparities and, as many noble Lords have said, it causes a great, heavy financial burden. In fact, each year smoking costs society £12.5 billion, with a cost to the NHS of around £2.5 billion. We believe that making smoking obsolete would free up £15 billion per year, benefiting especially the most disadvantaged families and the most deprived communities.

Given the lack of evidence and the other measures being considered, the Government do not feel that the Bill is appropriate at this point in time. However, the Bill’s requirements will be considered as part of the wider range of regulatory proposals to support our smoke-free 2030 ambition. We want to see evidence-based, targeted proposals and to make sure that they are effective.

I once again thank my noble friend Lord Young of Cookham for this important debate and encourage him to continue pressing the Government. I also thank noble Lords for their insightful contributions.

Covid-19 Update

Debate between Lord Naseby and Lord Kamall

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

All I can do is thank the noble Baroness for her question. I will have to double-check; as she will imagine, I do not have all the answers at the moment. Throughout the day, as I was preparing for this, the advice was changing constantly, and things were being swapped in. Advisers from the Department of Health and Social Care were saying, “This is the latest advice”, but it was changing literally hourly. I will try to get the latest advice and share this with noble Lords.

[Lord Naseby (Con)]

In light of the overall success of the vaccination programme, is it now a condition of employment that every new recruit to the NHS, at every level, must be vaccinated against Covid and agree to accept any future recommendations on protection against it?

[Lord Kamall (Con)]

As my noble friend will be aware, vaccination as a condition of deployment has been brought in for the social care sector. It will be brought in for the wider NHS, but there is a grace period in certain cases. Management are being encouraged to meet with staff to encourage them, particularly staff who are vaccine-hesitant. There is a grace period to see us through the winter period; it runs up to April next year. However, we are encouraging as many members of NHS staff as possible to get vaccinated and we have a high rate of vaccination so far.

Smoking Cessation: Prescription of E-cigarettes

Debate between Lord Naseby and Lord Kamall

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

As the noble Lord will know, some of the issues are related to leaving the EU, but it is interesting to learn from conversations with the MHRA that it is hugely excited about its ability to be more global in its outlook and to be a centre of expertise that many people across the world will want to learn from. With respect to international engagement, as well as making sure that it updates its guidelines to take account of medical technology there will be ongoing reorganisation and changes, and it hopes to be fit for purpose for many years to come.

[Lord Naseby (Con)]

My Lords, is the Minister aware that, as I understand it, there is a problem with the MHRA budget? This is important work. Furthermore, is it not a fact that the industry itself is supporting this work?

[Lord Kamall (Con)]

It is very important that we get the MHRA to approve these e-cigarette products. The MHRA is seen as a jewel, to which many experts from other countries look. One of my roles is international health diplomacy, and many people I talk to from other countries are very impressed with the work of both NICE and the MHRA. We can use that in our international health diplomacy.